This proposal requests five years of funding to examine the mental health needs and use of mental health services by a particularly vulnerable segment of the child population, children who are placed in foster care. The proposed study will detail baseline behavioral problems, developmental levels, health status, and adaptive functioning in all 2 to 6 year old children placed in foster care in two geographically and services-system distinct areas of Connecticut: Waterbury and Danbury/Torrington. This study will use a 2-group quasi- experimental design to compare two cohorts of foster care children: Waterbury children who receive a comprehensive baseline mental and physical health assessment in the Foster Care Clinic (FCC) of St. Mary's Hospital and Danbury/Torrington foster care children who receive only routine mental and physical health services. The specific aims of this study are to determine: 1) the extent to which mental and physical health needs of foster children vary in the two cohorts; 2) whether FCC children have more mental health problems recognized and referrals for specialty mental health services made; 3) whether receipt of specialty services and/or parent visitations influence 18-month postentry behavioral, adaptive, or foster care status; and 4) the influence of the foster family environment on adjustment to foster care and 18-month functioning. In year 1 we will enroll 60 families in each site and do six-month reinterviews on the initial 30 enrolled in each site. We will augment the FCC procedures to include an adaptive functioning measure and a family environment measure. Foster families and children in Danbury/Torrington will have all FCC assessments done by specially trained interviewers. Year 2 will complete enrollment in both sites, administer the 12- and 18-month follow-ups to the first 30 families enrolled in each site, and administer the 6- and 12-month interviews to the second 30 families enrolled during Year 1 in each site. Year 3 will complete 12- and 18-month follow-ups on all families. Years 4 and 5 of this research will be devoted to data analysis and report writing. Medical records of Danbury/Torrington will be abstracted form the offices of community physicians. Information on specialty mental and physical health services for both groups will be ascertained.